Anti-sag brackets can help certainly, but they aren't strictly necessary if you can get the GPU slotted well and make sure the screws are properly tight. Some GPUs don't have the rear bracket properly tied into the heatsink, which can lead to additional sag, but some do and are much more rigid.
You do need decent airflow through the case. Doesn't necessarily mean bottom fans, just sufficient flow so that the GPUs heat can be removed from the system.
For these you can just lower the power target below 100%. You can run it as low as you want, up to you when to start prioritizing performance.